News of the devastation caused by aids has been a steady drumbeat for decades now, and it keeps getting louder. The New York-based Council on Foreign Relations recently reported that 39 million people are expected to die of the disease in the next five or 10 years, and warns that some countries may find themselves unable to perform basic functions of governance. For the past five years, former U.S. ambassador Richard Holbrooke has been at the forefront of the war on AIDS, acting as CEO of the Global Business Coalition on HIV/AIDS, a member-supported group that works to enlist corporations to fight the disease. NEWSWEEK's Fred Guterl spoke with him about the growing crisis. Excerpts:
GUTERL: How bad is the situation?
HOLBROOKE: AIDS is unquestionably the worst health crisis in 700 years, since the Black Death. It decimates societies, and if it's not stopped it can wreck the social fabric and security of entire nations. This is already happening in parts of Africa, and other countries from Papua New Guinea to India are threatened. The fastest-growing AIDS rates in the world are in Russia, Ukraine and Estonia. Therefore, it is correct, in my view, to call it a national-security issue.
Africa, though, is still the biggest problem?
Africa is the heart of the problem, and South Africa is its epicenter. The South African government has come under well-deserved criticism for being slow to react to the problem. The Mbeki government has not been a very strong voice in this issue. They've been famously confused over it. They have undermined the effort to educate people on how to prevent its spread and how to deal with it. Church leadership in many countries has also been slow.
But it's not just an African disease. India has the first or second largest number of AIDS victims already, and the Indians are in heavy denial--they don't spend many resources on it. The new government is better than the last government, but not better enough. By denying the problem, the Indians are actually letting it spread, undetected, so the explosion will come down the road when it's too late.
In what sense is India in denial?
They haven't declared it a national emergency. They talk about it occasionally, but they don't have an all-out national campaign of prevention and education. They haven't put enough resources into it.
Other than Africa, is India the most worrisome?
I definitely worry about India more than Russia or China, because of the size of the population, the density and the fact that it can spread much more rapidly in those circumstances. China's problem is real, but precisely because China uses such brutal and draconian methods that no democracy could use, they're likely to be able to contain it. Russia is a major problem. But if you polled 100 AIDS experts in the world, they'd vote India as the most worrying, aside from Africa.
Why is denial so problematic?
AIDS spreads most rapidly when people are in denial about what causes it and how to prevent it. Ninety-five percent of all the people in the world who are HIV-positive don't know it, which means that they're unintentionally spreading it for the seven or eight years it lies without any symptoms in a person's body. Prevention is the No. 1 issue. Otherwise, the amount of money we spend on treatment will be a bottomless pit. Nothing is going to work unless the spread of it is stopped, which means prevention, which means testing.
Is the World Health Organization's effort to administer antiretrovirals to 3 million people by year-end making a dent in the problem?
Even if [the program] succeeded--and they have now admitted that they won't make it--in 2005 about 4.2 million people will get infected with HIV. It's the tortoise and the hare, and the hare is going to win. If ever an ounce of prevention was worth a very large pound of cure, it's in this area. That means condoms, abstinence, the development of female microbicides (which everyone is working on), education and, above all, testing. We will never get in front of the disease and stop it until we put more effort into prevention. Testing must be confidential, and the disease must be destigmatized. The stigmatization issue is enormous, but testing must be encouraged.
One country in the world has done this: Botswana, with 30-plus percent infection rate, has moved from purely voluntary testing to highly encouraged testing--they've increased testing from about 7 percent to over 90 percent in the last year. The result is the beginning of a turnaround.
What can businesses do to combat the AIDS epidemic?
They have a vital role to play in the fight against AIDS. It's in their own financial interests to do so, because otherwise large companies are going to find that they have to keep training new workers. So they have to get heavily engaged in the prevention and treatment of the disease. If they operate in heavily affected areas, they should encourage testing, free counseling and free treatment.